The Jerk Disorder, the Genius Syndrome: the Many Infuriating Faces of MedicalizationOnce upon a time, not too long ago, everybody who was anybody either had bipolar disorder or was “believed” to have had it. It was the affliction of rock stars, whose habit of trashing hotel rooms and the penchant for irrational behavior were seen as signs of a tortured genius. These days, bipolar disorder retains some popularity, but after more than a decade of movies celebrating subdued quirkiness as the new cool (starting with Amélie), Asperger’s Syndrome — the pastel-colored end of the Autism Spectrum — is all the rage. Don’t get me wrong: there are people living with serious, debilitating psychiatric and neurological conditions. But there is also an enormous crowd of au courant hipsters who see the “aspie” label as a mark of the distingué or, alternatively, a handy label to explain behavior that is rude, immoral or unusual. And boy, how easily they diagnose themselves and others.
I spent some time feeling rather lost at the beginning of this entry, despite having strong emotions on the subject. The educated public’s love affair with Asperger’s Syndrome is all over the map: I have heard obviously neurotypical people muse about their “undiagnosed Asperger’s” based on their history of nerdhood; I have also heard people dismiss those who irked them as “probable Asperger’s”, simply based on the latter’s unpleasant behavior; and I have also heard important historical figures, from Lord Byron to Albert Einstein, being characterized as “possibly Asperger’s” based on a history of relationship problems and artistic or scientific genius. Eventually, I realized that medicalization is hard to pinpoint because as an exercise in narcissism and entitlement, it manifests itself in many different, often contradictory, ways.
Broadly, the term “medicalization” refers to the continuous expansion of medicine and quasi-medicine (such as psychotherapy and counseling) into areas of life that have not traditionally been — and arguably should not be — the province of “experts”. A small number of social scientists have been trying to draw attention to medicalization since the 1970’s, mainly complaining about the encroachment of specialists who have succeeded in redefining such things as old age, childhood, normal pregnancy, non-conforming behavior, and even marriage as medical conditions or at least problems that require the intervention of a professional. As for me, I don’t see professionals themselves as a problem as much as a culture that’s steeped in entitlement and self-aggrandizement.
Medicalization is a vicious cycle: for the first time in history, we live in a world that allows us to presume that existence without discomfort is the normal state of things. When we experience discomfort, we want it fixed — and preferably to have someone else do it for us, rather than do the dirty work ourselves. But the more elaborate the ways of keeping us good and happy get, the more sensitive we become to being bothered, and the more indignant when anything places us outside of our comfort zone.
Characterizing a personality as a medical problem or condition serves functions that fall into three distinct categories:
(1) On the one hand, claiming to be an “aspie” (or indeed, a sufferer of any number of other psychiatric or neurological disorders) provides one with an excuse for behavior that hurts others. Call that person on his or her reprehensible behavior, and you will quickly find yourself accused of insensitivity. Moreover, once a character flaw is recast as an incurable condition, there is no longer a moral obligation to work on it. Instead the person who exhibits such a flaw can now characterize himself as a hero and a martyr for having to “live with the horror of ____ for the rest of my life”. A major downside of this particular aspect of medicalization is that it internalizes social or situational problems: when it comes to matters of the mind, if you don’t expect things ever to get better, they never will.
(2) On the other hand, claiming that a person whose behavior is objectionable is an “aspie” (or a sufferer of some other disorder) allows us to deny that this person may be, well, just bad — deliberately. In part, this is an extension of the Just World Hypothesis (which, ironically, is often ridiculed by the very people guilty of embracing it). It is truly astounding to me, how many people simply refuse to consider the possibility that someone who acts like an asshole may actually be an asshole, not a mentally ill person. Many of us feel the instinctive urge to erase the line between personality and mental illness precisely because we do not want to confront the reality that people can be in their right minds and yet act cruelly, selfishly or immorally.
(3) On yet another hand, slapping a label on someone who is giving us trouble allows us to not take that person seriously — and possibly to force that person to shut up.
As much as self-indulgence and entitlement are grating, it is that third effect of medicalization that we should ponder with particular caution. In the 1990’s and early 2000’s, the label of Münchausen Syndrome By Proxy — a legitimate but extremely rare condition — was widely used as a weapon against mothers who dared advocate for their sick children, or mothers whose children died in infancy from congenital disorders. Among the “symptoms” on the basis of which women had their children taken away and even been convicted of abuse and murder were the following:
MSBP was used to keep costs down, to indulge misogynistic hatred, to retaliate against annoying patients — and after ruining countless lives, it predictably generated a backlash where even legitimate cases of MSBP are almost impossible to prove.
The Soviet Union, in its heyday, went further, and used psychiatry punitively against political dissenters. Anyone who did not toe the party line was diagnosed with “sluggish schizophrenia”, institutionalized indefinitely and subjected to unspeakable torture under the pretext of “treatment”.
We can tell ourselves all we want that what happened in the USSR, one of the most repressive totalitarian regimes in history, would never happen in the enlightened West — but we would be wrong. We have a culture that provides a fertile ground for punitive psychiatry. If you let medicine address questions of morality and social problems, it is only a matter of time before it will address questions of politics.
For what it’s worth, I am not a mental health professional — but I am greatly dismayed by our value system, which dictates that if a person repeatedly does something we don’t like, or says something we don’t agree with, then we slap him with a label that states he has a disease. (Yes, yes, I’m aware “disease” isn’t the proper term here, but “disease” is what lay people hear when you say “disorder” or “syndrome”. We can decry the ignorance or the sloppy thinking of the general public, but the implication of some organic, basic, foundational abnormality that is created whatever term you use is an important part of the stigmatization of objectionable behaviors and beliefs.)
I am also dismayed by what I see as the growing need for validation through medicalization; plenty of people feel that their traumatic or tragic experiences, or their dark or sad thoughts are somehow not real, serious, or valid unless they are characterized as a mental pathology. One of the most remarkable things I noticed when arguing with people about the issue of overdiagnosis is that they tend to perceive an attack on the diagnosis as a denial of their experience. Which begs the question: if the painful memories of being abused as a child sometimes keep you awake at night, WHY is it so important to attach a fancy-sounding label to it and to imply that you are not right in the head? Is the experience of child abuse less real, are the reactions to it less understandable, less worthy of sympathy if they are not pathologized? I have found that people vested in believing themselves to be suffering from some nebulous yet incurable disorder have a hard time wrapping their heads around the fact that someone may believe them and empathize with them on the subject of their experiences, yet question whether those experiences are tantamount to a medical condition.
I don’t deny that there are some people whose behaviors or beliefs are so far beyond the pale that they can fairly constitute a pathology. But I think we should be very careful when expanding the criteria for pathology to include anything and everything that places us outside our comfort zone.
I suppose the rationale beyond loose criteria and overdiagnosis (especially by lay people) is “well, there is no harm in giving someone a diagnosis just in case“. But there is a harm, great harm, that looms from all this. There is the growing cost of care, for one. Rejection of responsibility, another. Internalizing problems, which in many circumstances, will make it more difficult for people to cope with their circumstances. Increasing sensitivity to stress and growing dependence on drugs and medical intervention just to deal with the vagaries of life. But most importantly, and most dangerously — pathologizing controversial speech or objectionable political opinions, and using psychiatry and mental health professionals as tools for social and political control. It’s true, we don’t have the awesome coercive mechanism of a totalitarian state — but reflexively medicalizing behavior, thoughts, and lifestyles that offend the public creates fertile ground for using medicine and psychiatry to silence dissent.
Once again — I don’t deny the reality of serious psychiatric and neurological conditions. But, life, with all its unpleasantness, is not a disease; a personality is not a disorder; being uncomfortable or different doesn’t mean you are sick.
I wrote a very long entry, and I don’t have Asperger’s.